November 9, 2000
STATE OF CONNECTICUT LONG TERM CARE INSURANCE PROGRAM
By: Lynn Marx, Research Attorney
You asked for a summary of the State of Connecticut Long Term Care Insurance Program (Program).
The Program is an insurance policy offered to all State employees, retirees, and eligible family members for long-term health care. The Program covers the expenses of home health care workers, visiting nurses, therapists, adult day care, and other home based services. It also covers nursing home and assisted living facility care.
The Program allows participants to shelter part of their assets if they apply for assistance and grants participants certain income tax benefits. It is one of seven insurance plans offered to State employees and retirees under the Supplemental Employee Benefits Program (CGS § 3-123g). The participant pays the entire premium. Premiums are not refundable.
LONG TERM CARE
Long term care is needed when someone (1) has been affected by an event such as debilitating illness or accident that renders him unable to perform activities of daily living, or (2) has a cognitive impairment that affects his ability to think, reason or remember. Activities of daily living are basic daily tasks such as eating, toilet use, bathing, dressing, and getting in an out of bed or a chair.
PROTECTION OF ASSETS
The Program is approved by the Connecticut Partnership for Long Term Care (CGS §§ 17b-253, 254). The Connecticut Partnership for Long Term Care allows people who buy approved plans to shelter some of their assets if they later need to apply for Medicaid for nursing home, home health, or other community-based care. If someone has an approved plan, he may exclude from Medicaid's spend-down requirements an amount equal to what the plan has paid out in covered benefits. For example, if he buys $100,000 of coverage and his long-term care costs exceed $100,000, he may apply for Medicaid assistance and keep $100,000 of assets intact.
The Program is also a qualified long-term care insurance contract under the Federal Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191). A qualified long-term care insurance contract provides preferential income tax treatment for payment of premiums and benefits. Premiums paid (up to a certain limitation) can be counted as unreimbursed medicals for Federal income tax purposes and benefits paid by the plan will not be counted as taxable income.
According to Eric Bleimeister, (860) 409-3326, who works for the company that markets the Program to State employees, full-time State employees are guaranteed entry into the Program during a 120-day open enrollment period. The starting date of the open enrollment period varies from agency to agency; some agencies' open enrollment periods have already ended while others have not yet started. New full-time State employees are guaranteed entry into the Program during the first 120 days after their first 6 months of employment. All other State employees, retirees, and eligible family members must complete an application containing several health questions. The application can be denied.
All benefits available under the Program are paid for in their entirety by voluntary payroll or pension deductions. The cost of the premium depends on the specific plan and the participant's age. Attached is a list of the premium rates for each plan. Rates do not change due to changes in health or age. Rates may change across the board due to experience and the cost of living. Any changes in rates must first be approved by the Connecticut Department of Insurance.
If a State employee, retiree, or eligible family member elects to participate in the Program and later quits, his contributions are non-refundable. A State employee who leaves his employment can continue coverage by paying the required premium.